Transplantation under scrutiny in Washington and the media: compilation of recent links by Greg Segal, via Frank McCormick

The organ transplant ecology is complex, with sometimes perverse incentives in the interfaces among OPOs (Organ Procurement Organizations), donor hospitals, and transplant centers (not to mention dialysis clinics, nephrology practices, government agencies, and subcontractors like UNOS).  Frank McCormick forwards the following compilation distributed by Greg Segal, mostly focused on recent criticisms (some more informed than others) of OPOs. (Having recently spent a day talking to OPO leaders, and not long before that to those running transplant centers, I'm aware that there are different opinions on the multiple causes of  problems afflicting transplantation

Frank writes:
"Greg Segal (founder & CEO of Organize, which is attempting to reduce the U.S. organ donation shortage) sends along this excellent compilation of references for those who want to comment on two current proposals by agencies of the Department of Health and Human Services (HHS):

a.    Health Resources and Services Administration (HRSA): “Removing Financial Disincentives to Living Organ Donation” (deadline – 2/18/20)

 https://www.federalregister.gov/documents/2019/12/20/2019-27532/removing-financial-disincentives-to-living-organ-donation

b.    Center for Medicare and Medicaid Services (CMS): “Revisions to the Outcome Measure Requirements for Organ Procurement Organization” (deadline – 2/21/20)

https://www.federalregister.gov/documents/2019/12/23/2019-27418/medicare-and-medicaid-programs-organ-procurement-organizations-conditions-for-coverage-revisions-to#open-comment

Key points for comments (due by February 21st at 5pm ET, via submission here)

• Although 95% of Americans support organ donation, objective research suggests that organ procurement organizations (OPOs) only recover about 35% of potential donors, leaving as many as 28,000 organs unrecovered every year.
• Because the majority of patients on the organ waiting list are in need of kidneys, OPO underperformance contributes to a $35 billion annual expense to Medicare. 
• As Senators from the Finance Committee wrote in a February 10th 2019 oversight letter: “Because OPOs operate as regional monopolies, rigorous oversight is critical to ensure that all 58 OPOs are faithfully executing their mission of organ recovery.”
• As Secretary of Health and Human Services Alex Azar said: “We’re going to stop looking the other way while lives are lost and hold OPOs accountable."
• With almost 115,000 patients waiting for a lifesaving organ transplant, it is imperative that CMS implements the proposed metrics as strongly and quickly as possible, especially since the majority of OPOs (37 of 58) are failing one or both key metrics.

Context on why OPO reform is critical to helping more patients access organ transplants

• Every day, 33 Americans die or are removed from the organ waiting list because a transplant is unavailable. Additionally, because there is such a large gap between supply and demand, many Americans in need of transplant never even reach the waiting list. Research indicates that the true death toll may be as high as 118 Americans per day just from the kidney shortage alone.
• The shortage of deceased donor organs results in part from inefficiency from federal monopoly contractors, called organ procurement organizations (OPOs), which too often fail to recover organs for transplant. (See NYT whistleblower video.) 
• Research cited by the Trump Administration shows that a more efficient organ donation system could recover up to 28,000 more organs for transplant each year.
• This includes 17,000 kidneys; almost 8,000 livers; 1,500 hearts; and 1,500 lungs.
• Because of costs to Medicare, OPO reform could also save up to $12 billion over 5 years in avoided dialysis costs.
• A key problem is OPOs are allowed to self-interpret and self-report their own performance, leading to a lack of transparency and accountability. As a result, no OPO has lost a government contract in decades.
• In fact, reporting suggests the current standards are unenforceable.
• The New York Times Editorial Board highlighted “an astounding lack of accountability and oversight in the nation’s creaking, monopolistic organ transplant system is allowing hundreds of thousands of potential organ donations to fall through the cracks.” 
• HHS/CMS’s proposed rule, published on December 17th, moves to objective data from the Centers for Disease Control, and shows the majority of the nation’s 58 OPOs are failing proposed performance metrics.
• CMS estimates that just bringing OPOs up to minimum compliance standards would mean 5,000 more deceased donor transplants every year. 
• Responses to the proposed rule are due by February 21st at 5pm ET.

Additional Resources

• Day One Project paper co-authored by Donna Cryer (President & CEO of Global Liver Institute), Jennifer Erickson (former Obama staffer), Crystal Gadegbeku (Council member, American Society of Nephrology and Section Chief of Nephrology, Temple University), Greg Segal (founder & CEO of Organize), and Abe Sutton (former Trump staffer)
• Senate Finance Committee oversight letter to Inspector General inquiring about OPO underperformance, fraud, waste and abuse, and conflicts of interest
• Senate Finance Committee oversight letter to UNOS inquiring about abdication of oversight responsibilities over OPOs 
• Representative Katie Porter oversight letter regarding OPOs, specifically the LA-based OPO known as One Legacy
• Senators Elizabeth Warren and Richard Blumenthal oversight letter to CMS regarding OPO performance and evaluation metrics
• Patient groups writing to Administrator Verma calling for OPO accountability: American Association of Kidney Patients, American Society of Nephrology, Cholangiocarcinoma Foundation, Fatty Liver Foundation, Global Liver Institute, Liver Education Advocacy and Prevention Services, Renal Physicians Association
• Politico Pulse Podcast interview with Greg Segal about the need for OPO reform

News

• Washington Post on Senate Finance Committee OPO oversight letter
• Associated Press on HHS proposed OPO rule

• Politico Pulse on HHS proposed OPO rule
• Full Frontal with Samantha Bee on OPOs never losing contracts
• Kaiser Health News about UNOS and OPOs losing organs in transit

Op eds

• USA Today: Andy Slavitt and Adam Brandon, “Here's how organ donation reform could save thousands of lives, billions in tax dollars”
• The Hill: Jennifer Erickson & Abe Sutton, “It’s Time to Provide Needed Reform to the Organ Donation System”
• New York Post: Dara Kass, “America’s Deadly Failure on Organ Donations”
• CNN: Bakari Sellers, “Dealing with a broken organ donation system after my 4 month old had liver failure”
• STAT: Laura and John Arnold, “A simple bureaucratic organ donation fix will save thousands of lives”
• Washington Post: “The Trump administration is actually doing something great on health care”
• Washington Post: Erika Zak, 39-year old mother who died during transplant, “A posthumous letter to my daughter”

Once-a-year dating match services for college students

Valentine's Day is a good day to take note of dating services that operate only once a year, particularly since one of them, Datamatch, operates on a Valentine's Day schedule.  It started at Harvard, and has now spread to other universities.  Here's a story from the Harvard Crimson:

Datamatch Sends Love to Thirteen Schools   By Michelle G. Kurilla
"Datamatch, a free matchmaking service run by the Harvard Computer Society, is now available to students at 13 schools.

Program organizers expanded Datamatch's reach from last year, when the service was available at four colleges and universities. HCS, which launched the program in 1994 exclusively for Harvard College students, also offered Datamatch to students at Brown University, Columbia University, and Wellesley College in 2018.
...
"This Valentine’s Day, Datamatch will share the love on thirteen other campuses, in addition to Harvard: Boston College, Brown University, Carleton College, the University of Chicago, the Claremont Colleges, Columbia University, Cornell University, MIT, Wellesley College, University of Wisconsin-Madison, Washington University in St. Louis, and Yale University.
...
"Matches will be released on February 14 across the country."
***********

And from The Oxford Student:
The Oxford Marriage Pact Is Back!  by Oz Myerson
"The Oxford Marriage Pact is back, fuelling discussion, debate, and hope among a large proportion of Oxford students this week. In the run up to Valentine’s day, it has been easy to spot many events geared towards hopeful lovers – The Oxford Marriage Pact sits comfortably amongst RAG Blind Dates, the Freud’s Jazz society Valentine’s evening, and the recent Magdalen x St. Hilda’s take-me- out event."
*********

Stanford's Marriage Pact doesn't run on Valentine's day, but is becoming a campus event. Here's a recent story from the Stanford Daily:
Stanford Marriage Pact releases second annual Campus Report  
by Danielle Echeverria

"The number of participants in the Marriage Pact — which asks students about a range of topics from religion and politics to sex and spontaneity — has grown each year since its advent three years ago. In total, 91.4% of the class of 2020 has sought a match at least once. The Marriage Pact has had 8,621 unique Stanford undergraduate participants across its three years of existence.

"Beyond the matching algorithm, the Marriage Pact has generated aggregated data on how Stanford students think and what they value. For the second year in a row, the Marriage Pact team has released a Campus Report that highlights trends in the data.
...
"According to the Report, approximately two-thirds of students do not think it is important for their children to be raised with religion. Nearly half of students expect their children to attend Ivy League-tier schools and do not think it is important to make more money than their peers."

The market for chocolate

The NY Times has the story, just in time for Valentine's Day:

Everything You Don’t Know About Chocolate
The beloved bar has come a long way in quality and complexity. Here’s a primer on how it’s made, and how to choose the best and most ethically produced.
By Melissa Clark

"One of the biggest ethical concerns about chocolate-making is the cacao supply chain. In the current system, the vast majority of cacao beans are sold as a commodity crop without regard to quality. Because farmers aren’t paid more for better beans, there’s no incentive for them to plant finer-flavored cultivars. Nor would they have the money to do so. In West Africa, which grows 60 to 70 percent of the world’s beans, many cacao farmers live below the poverty line, making less than $1.90 a day.
...
"While some chocolate makers buy directly from farmers, most of the micro, bean-to-bar makers in the United States get beans from one of two direct-trade cacao importers, Uncommon Cacao and Meridian Cacao. Both have strong social goals that include living wages for the farmers."

Online dating while female--the case of Bumble

The above figure is from the following Bloomberg story about (and critical of) the dating app Bumble.

For Bumble, the Future Isn’t Female, It’s Female Marketing
Whitney Wolfe Herd set out to build a safer dating app for women, but it’s not clear that she’s made a measurable difference. by Claire Suddath.

Organ sharing in San Diego--UNOS Region 5 educational collaborative

I'll be flying to San Diego later this morning to take part in the UNOS Region 5 Educational Collaborative

Here's the Agenda.

I'll speak at 1:00pm:
Who Gets What and Why?
•An interview with Nobel Prize winning economist Alvin Roth
 Moderator: Brian Beck, Donor Connect
Who Gets What and Why? •An interview with Nobel Prize winning economist Alvin Roth Alvin Roth Ph.D. Organization Moderator: Brian Beck, Donor ConnectWho Gets What and Why? •An interview with Nobel Prize winning economist Alvin Roth Alvin Roth Ph.D. Organization Moderator: Brian Beck, Donor Connect

An experiment with a blood donor registry in Australia

Forthcoming in Management Science:
Redesigning the Market for Volunteers: A Donor Registry
Stephanie A. Heger, Robert Slonim, Ellen Garbarino, Carmen Wang, Daniel Walle

Abstract. This paper addresses volunteer labor markets where the lack of price signals, nonpecuniary motivations to supply labor, and limited fungibility of supply lead to market failure. To address the causes of the market failure, we conduct a field experiment with volunteer whole blood donors where we introduce a market-clearing mechanism (henceforth: the Registry). Our intention-to-treat estimates suggest that subjects invited to the Registry, regardless of joining, are 66% more responsive to critical shortage appeals than control subjects. While the Registry increases supply during a critical shortage episode, it does not increase supply when there is no shortage; thus, the Registry significantly improves coordination between volunteer donors and collection centers, thereby improving market outcomes. We find evidence that the Registry’s effectiveness stems from crowding-in volunteers with purely altruistic motives and volunteers with a preference for commitment.

"In partnership with the Australian Red Cross Blood Service, we introduced a Registry throughout Australia using a large-scale field experiment that unfolded over two rounds. We drew the sample for our experiment from the population of long-lapsed donors. Long-lapsed donors are donors who have given at least one successful whole blood donation but have not donated in at least the past 24 months"

*******

Update: Management Science, Volume 66, Issue 8, August 2020

 

The blowback following Trump's executive order concerning dialysis

It turns out that traditional dialysis providers are not rallying behind President Trump's suggestion that home dialysis could serve many more patients.

The Washington Post has the story:

Trump touted a kidney-care initiative in his State of the Union. But things are not going so smoothly. 
By Christopher Rowland

"The Trump administration has delayed a signature health-care initiative to boost the number of U.S. kidney patients who undergo dialysis at home and get transplants, amid resistance from kidney doctors and large dialysis companies whose payments from the Medicare system could be reduced under the plan.

Trump listed his plan to improve kidney care as a key initiative in his State of the Union speech this week.

But doctors and large dialysis corporations are seeking to remove or reduce proposed financial penalties for underperforming clinics. The new plan was supposed to take effect Jan. 1, but now the timetable is unclear."

Deceased donor organs, lost to transplantation due to problems in transportation

NBC News has the story:

Lost luggage: How lifesaving organs for transplant go missing in transit
Scores of organs — mostly kidneys — are trashed each year and many more become critically delayed while being shipped on commercial airliners.
Feb. 8, 2020, By JoNel Aleccia

" a new analysis of transplant data finds that a startling number of lifesaving organs are lost or delayed while being shipped on commercial flights, the delays often rendering them unusable.
...
"Between 2014 and 2019, nearly 170 organs could not be transplanted and almost 370 endured “near misses,” with delays of two hours or more, after transportation problems, according to an investigation by Kaiser Health News and Reveal from the Center for Investigative Reporting. The media organizations reviewed data from more than 8,800 organ and tissue shipments collected voluntarily and shared upon request by the United Network for Organ Sharing, or UNOS, the nonprofit government contractor that oversees the nation’s transplant system. Twenty-two additional organs classified as transportation “failures” were ultimately able to be transplanted elsewhere.

"Surgeons themselves often go to hospitals to collect and transport hearts, which survive only four to six hours out of the body. But kidneys and pancreases — which have longer shelf lives — often travel commercial, as cargo. As such, they can end up missing connecting flights or delayed like lost luggage. Worse still, they are typically tracked with a primitive system of phone calls and paper manifests, with no GPS or other electronic tracking required.

"Transplant surgeons around the country, irate and distressed, told KHN that they have lost the chance to transplant otherwise usable kidneys because of logistics.

...

"One contributing factor is the lack of a national system to transfer organs from one region to another because they match a distant patient in need.

"Instead, the U.S. relies on a patchwork of 58 nonprofit organizations called organ procurement organizations, or OPOs, to collect the organs from hospitals and package them. Teams from the OPOs monitor surgeries to remove organs from donors and then make sure the organs are properly boxed and labeled for shipping and delivery.

"From there, however, the OPOs often rely on commercial couriers and airlines, which are not formally held accountable for any ensuing problems."

***************

And here's a related podcast at Reveal news: Lost in Transplantation


HT: Frank McCormick 

Market designs to reduce the costs of high frequency trading, by Baldauf and Mollner

A forthcoming paper by Markus Baldauf and Joshua Mollner considers two designs to reduce the costs of (and incentives for) very high frequency trading. One is frequent batch auctions (on also which see Budish et al.), and the other is allowing market  participants to cancel bids or asks while imposing a delay on acceptances of those bids or asks, so that spreads will not have to be widened to defend against faster traders.

High-Frequency Trading and Market Performance
Journal of Finance, Forthcoming
Last revised: 25 Jan 2020
Markus Baldauf
University of British Columbia (UBC) - Division of Finance
and
Joshua Mollner
Northwestern University - Kellogg School of Management



Abstract
We study the consequences of high-frequency trading (HFT) — and potential policy responses — via the tradeoff between liquidity and information production. Faster speeds facilitate HFT with consequences for this tradeoff: information production diminishes because informed traders have less time to trade before HFTs react, but liquidity (measured by the bid-ask spread) improves because informational asymmetries decline. HFT also pushes outcomes inside the frontier of this tradeoff. However, outcomes can be restored to the frontier by replacing the limit order book (LOB) with either of two alternative mechanisms: delaying all orders except cancellations or frequent batch auctions.

What is the cost of high frequency trading? by Aquilina, Budish, and O'Neill

A recent WSJ article highlights a paper by Aquilina, Budish, and O'Neill:

Ultrafast Trading Costs Stock Investors Nearly $5 Billion a Year, Study Says
U.K. regulator’s study says ‘latency arbitrage’ imposes a small but significant tax on investors
"High-frequency traders earn nearly $5 billion on global stock markets a year by taking advantage of slightly out-of-date prices, imposing a small but significant tax on investors, a new study says."
********

And here's the original paper from Britain's Financial Conduct Authority:

Quantifying the High-Frequency Trading 'Arms Race': A new methodology and estimates
Occasional papers 27/01/2020
by Matteo Aquilina, Financial Conduct Authority,
Eric Budish, University of Chicago Booth School of Business and NBER and Peter O’Neill, Financial Conduct Authority


"The authors use stock exchange message data to quantify the negative aspect of high-frequency trading, known as 'latency arbitrage.' The key difference between message data and widely-familiar limit order book data is that message data contain attempts to trade or cancel that fail."

 Summary:
"The authors use stock exchange message data to quantify the negative aspect of high-frequency trading, known as “latency arbitrage.” The main results show:

• races are frequent, fast and worth only small amounts per race
• a large proportion of daily trading volume is in races
• race participation is concentrated
• in aggregate, these small races make up a meaningful proportion of price impact
• in aggregate, these small races add up to meaningful harm to liquidity
• in aggregate, these small races add up to a meaningful total ‘size of the prize’
• The paper finds that while there is only a small detriment per transaction as a result, it adds up to a 17% reduction in the cost of liquidity and $5bn a year in tax on trading volume."

70th Anniversary of the National Science Foundation (NSF)

The (U.S.) National Science Foundation is celebrating its 70th anniversary today in Washington DC.
 Here's the program: 70th Anniversary Symposium

I'll be participating in the afternoon:

Science Breakthroughs
Panel featuring NSF-funded science breakthroughs from the last decade. The topics covered in this panel will feature a mix of major breakthroughs, as well as research that has led to significant impacts on society. In addition, the panelists will be a diverse set of researchers, including those earlier in their careers.

Moderator: Amy Harmon, Correspondent, New York Times
Panelists: Jennifer Dionne, 2019 Waterman Award recipient & Associate Professor, Stanford University
Shep Doeleman, 2019 Breakthrough Prize & NSF Diamond Award recipient & Director, EHT at Harvard-Smithsonian Center for Astrophysics
Margaret Leinen, Director, Scripps Institute & Vice Chancellor & Dean, Marine Sciences
Nergis Mavalvala, Professor & Associate Head, Department of Physics, MIT
Alvin Roth, Nobel Prize in Economics 2012 & Professor of Economics, Stanford University 

Market Design at 25, May 14-15 in Washington DC

The NBER is holding a conference in May, in Washington.

"The conference, which has been organized by Irene Lo, Michael Ostrovsky, and Parag Pathak, is timed to roughly commemorate the 25th anniversary of the first FCC spectrum auction, in 1994, the redesign of the National Resident Match Program (begun in 1995, completed in 1998), and the launch of the sulphur dioxide allowance-trading program under Title IV of the Clean Air Act Amendments (amended in 1990, initiated in 1995).  The conference goal is to assess the key contributions of market design in a number of specific fields and policy areas, and to identify key open questions that are priorities for future research."

Market Design @ 25

Authors Please upload your paper and slides here.

Irene Y. Lo, Michael Ostrovsky, and Parag A. Pathak, Organizers

May 14-15, 2020

JW Marriott Hotel, 1331 Pennsylvania Avenue, Washington, DC

Conference Code of Conduct

Thursday, May 14
8:00 am	Continental Breakfast
8:30 am	Spectrum Auctions
	- Opening speaker: Jessica Rosenworcel, FCC Commissioner
	- Overview: Paul Milgrom, Stanford University
	- Viewpoint: Evan Kwerel, FCC
9:55 am	Break
10:10 am	Matching and Broadening the Definition of Markets
	- Overview: Alvin Roth, Stanford University and NBER
	- Viewpoint 1: Edward Glaeser, Harvard University and NBER
	- Viewpoint 2: Susan Athey, Stanford University and NBER
11:20 am	Break
11:35 am	Market Design for the Environment
	- Overview: Michael Greenstone, University of Chicago and NBER
	- Viewpoint 1: Richard Schmalensee, Massachusetts Institute of Technology and NBER
	- Viewpoint 2: Nathan Keohane, Environmental Defense Fund
12:45 pm	Lunch
2:15 pm	Market Design in Healthcare
	- Overview: Amy Finkelstein, Massachusetts Institute of Technology and NBER
	- Viewpoint 1: Marc Miller, LJAF / Former MedPac
	- Viewpoint 2: Kate Ho, Princeton University and NBER
3:25 pm	Market Design in Transportation
	- Overview: Michael Ostrovsky, Stanford University and NBER
	- Viewpoint 1: David Shmoys, Cornell University
	- Viewpoint 2: TBA
4:35 pm	Break
4:50 pm	Market Design in Developing Countries
	- Overview: Kevin Lleyton-Brown, University of British Columbia
	- Viewpoint 1: Tavneet Suri, Massachusetts Institute of Technology and NBER
	- Viewpoint 2: Jishnu Das, Georgetown University
6:00 pm	Adjourn
6:30 pm	Conference Dinner
Friday, May 15
7:45 am	Continental Breakfast
8:15 am	Market Design for Education
	- Overview: Parag Pathak, Massachusetts Institute of Technology and NBER
	- Viewpoint 1: Derek Neal, University of Chicago and NBER
	- Viewpoint 2: Neerav Kingsland, City Fund
9:25 am	Break
9:40 am	Market Design for Organ Transplantation
	- Overview: Tayfun Sonmez, Boston College
	- Viewpoint 1: Nikhil Agarwal, Massachusetts Institute of Technology and NBER
	- Viewpoint 2: Jennifer Erickson, formerly White House OSTP
10:50 am	Break
11:05 am	Market Design for Public Housing
	- Overview: Nathan Hendren, Harvard University and NBER
	- Viewpoint 1: Winnie van Dijk, University of Chicago and NBER
	- Viewpoint 2: Marge Turner, Urban Institute
12:15 pm	Lunch
1:15 pm	Electricity Market Design
	- Overview: Mar Reguant, Northwestern University and NBER
	- Viewpoint 1: Bob Wilson, Stanford University
	- Viewpoint 2: Shmuel Oren, University of California at Berkeley
2:25 pm	Market Design in Online Markets
	- Overview: Preston McAfee, formerly Caltech and Microsoft
	- Viewpoint 1: Hal Varian, Google
	- Viewpoint 2: Irene Lo, Stanford University
3:35 pm	Break
3:50 pm	Market Design in Financial Markets
	- Overview: Darrell Duffie, Stanford University and NBER
	- Viewpoint 1: Eric Budish, University of Chicago and NBER
	- Viewpoint 2: Gary Gensler, Massachusetts Institute of Technology
5:00 pm	Adjourn

Presenting results anecdatally (and other stories about presenting data to policy makers)

I've recently been involved in several efforts to present data to policy makers who, rightly or wrongly, react more strongly to well-told stories than to comparisons of data distributions.

The reason that scientists of all sorts are distrustful of stories--i.e. anecdotes--is that anecdotes can be outliers, unrepresentative of the underlying data. (Think of political ads that feature particularly memorable crimes committed by paroled prisoners, or immigrants, etc.)

But while comparing data distributions may be more persuasive to scientists, anecdotes, responsibly presented, remain useful for communicating with non-scientists.  And so I've found myself arguing to colleagues that we should present data "anectdataly,"  by illustrating our statistical results with anecdotes that represent well the underlying statistical data.

So...we're in neologism territory here, inventing appropriate new words.

andecdatum. (plural: anecdata)

1. noun.  an anecdatum is a single story that represents the underlying data distribution, e.g. by illustrating its mean or mode. (Compare to "anecdote".)

anecdata

1. plural of anecdatum
2. a collection of stories that together illustrate key features of a statistical distribution (or comparisons of distributions) that may not be well illustrated by a single anecdatum.

anecdatal   

1. adjective: stories illustrating statistical evidence collected as part of systematic scientific evaluation: (as in "the statistical presentation was supplemented with anecdatal evidence.")

anecdataly (also anecdatally)

1. adverb. (as in "the executive summary was presented anecdataly and with summary statistics, with the details of the data presented in the body of the report.")

Unraveling of appellate court clerkships (only more so)

Steve Leider writes:

"I know you keep an eye on the unraveling of judicial hiring.  Listening to a podcast about the supreme court they gave an example of even more extreme advance hiring.  At about 51:30 minutes into this podcast (recorded at Michigan, ...) they talk about an Appeal's Court judge (Judge Katzmann, 2nd Circuit) currently hiring for the 2024 term.

https://strict-scrutiny.simplecast.com/episodes/standing-cheese 

 As one of the hosts noted - "A law student could get married, give birth, and have a baby - and the baby would be in pre-K before the clerkship even starts."